5 Recent Updates to Cancer Clinical Guidelines

Staying up-to-date on clinical guidelines is a must for care providers, as well as patients, but can be a challenge. Findings from recent research studies can inform cancer clinical guidelines. Additionally, organizations like the National Comprehensive Cancer Network (NCCN) and the US Preventive Services Task Force (USPSTF) have recommended updates to certain cancer treatment guidelines over the past few weeks; some of these updates are listed below.

1. Twice-yearly MRIs for early diagnosis of breast cancer

According to a new study published in Clinical Cancer Research, biannual magnetic resonance imaging (MRI) can more efficiently detect early breast cancer in younger women who are at a greater risk of developing the disease.

The at-risk women—enrolled based on mutations in their BRCA1 or BRCA2 genes, diagnosis of breast cancer or ductal carcinoma in situ before age 35, or a family history of breast cancer—underwent a dynamic contrast-enhanced (DCE) MRI every 6 months, in addition to a digital mammogram every 12 months. Those at high-risk who completed 5 years of study protocol were offered continued screening.

In this study, DCE-MRI every 6 months “performed well for early detection of invasive breast cancer in genomically stratified high-risk women,” said study author Gregory Karczmar, PhD, professor of radiology at the University of Chicago.

2. NCCN updates patient guidelines for endometrial cancer and uterine sarcoma

In early September, NCCN released updated treatment guidelines for endometrial cancer, which is expected to be the cause of more than 11,000 deaths in 2018. The Guidelines for Patients has a patient-friendly format that includes a glossary of terms as well as medical illustrations and have been endorsed by the nonprofit organization Facing Our Risk of Cancer Empowered.

“These guidelines go beyond a basic overview, to truly explain, in plain language, what experts agree are the best, most up-to-date treatment approaches,” Robert W. Carlson, MD, CEO of NCCN, said in a statement.

3. Sequential administration of trastuzumab and chemotherapy reduces cardiotoxicity in breast cancer

While long-term outcomes do not vary, administering trastuzumab sequentially, instead of concurrently, with neoadjuvant chemotherapy in women with HER2-positive breast cancer prevents cardiac side effects. These were the findings of a study led by researchers at the MD Anderson Cancer Center.

The trial, which enrolled 280 patients, found no difference in disease-free survival or overall survival in patients who were administered paclitaxel plus trastuzumab along with fluorouracil, epirubicin, and cyclophosphamide (FEC), compared with a regimen of FEC followed by paclitaxel plus trastuzumab.

4. New cervical cancer screening recommendations from USPSTF

The USPSTF has updated its 2012 recommendations on screening for cervical cancer among women aged 30 to 65 years. The new guidance recommends cotesting: A Pap test every 3 years or a Pap and human papillomavirus test every 5 years. The guidance does not recommend screening women younger than 21 years or older than 65 years.

The new guidance aligns with recommendations by 3 influential women’s healthcare groups: the American College of Obstetrics and Gynecologists, the Society of Gynecologic Oncology, and the American Society for Colposcopy and Cervical Pathology.

5. PARP inhibitor better than chemotherapy in advanced breast cancer

Phase 3 results from the EMBRACA trial have found the superiority of talazoparib, a PARP inhibitor, over chemotherapy in treating metastatic HER2-negative, BRCA1/2-positive breast cancer.

The trial randomized 431 patients 2:1 to receive talazoparib or a single-agent chemotherapy (capecitabine, eribulin, gemcitabine, or vinorelbine)—median progression-free survival was 8.6 months in the talazoparib arm and 5.6 months in the physician’s-choice-of-chemotherapy arm. Further, deterioration of overall health was 6.3 months in the physician’s choice arm but was 4-times longer (24.3 months) in the talazoparib arm.

Follow-up trials will evaluate the PARP inhibitor as a combination treatment.

Additional updates can be found here.